Declaration of Candidacy FormsDeclaration of Candidacy Form for Area Board of Directors Deadline for receipt of this form is October 15, 2021, time-stamped by 5:00 pm. Voting will take place at the UTLA North Area virtual meeting that begins at 4:30 pm on October 20, 2021. Name (required) As you would like it to appear on ballot. Affiliation NEA UTLA Area North Employee ID Number (required) Non-LAUSD Email (required) Street Address (required) City (required) State (required) Zip Code Home Phone Number Cell Phone Number (required) School Phone Number School/Site (required) Permission is granted for UTLA to give contact information to members and media when requested School SiteHome PhoneCell PhoneNon-LAUSD email Check those methods that are acceptable to give out. Permission is given for the Elections Committee to verify my membership and to determine that I meet the requirements to be a candidate for the office for which I have declared I agree I declare the above assignment information true to the best of my knowledge. (required) Checking this box represents your e-signature I, __________, candidate for the office of NEA North Area Director, do hereby declare that I will review the UTLA Election Manual and I understand I am responsible for following the rules in the Manual. In particular I understand that I cannot use any of the contact information I have acquired through my role within ULTA. I will assure that anyone working to assist me in my campaign is aware that all individuals working on my behalf are also responsible for following the rules in the UTLA Election Manual, including the use of contact information acquired through their role within UTLA. __________ Signature of Candidate __________ Date Signed If you have any questions or concerns, please contact the Elections Committee. If you have an urgent message for the Elections Committee, you may leave a message with Tara Thomas at 1–213–637–5165 during regular business hours.